More on Electroconvulsive Therapy (ECT)

By: Beth McHugh 2008

In our last article on this topic, we looked at the reasons why ECT
is used rather than conventional antidepressant medications only. Principally
utilized as a last port of call when other medication and modalities
have repeatedly failed, ECT is still mired in controversy.

While it is and has been a definite lifesaver for many sufferers of
deep depression, the technique does not enjoy a high popularity rating.
One of the principal reasons for this is that, despite the length of
time the method has been in use, coupled with numerous refinelments
in techniques, there are several serious side effects.

Another reason is that scientists do not yet fully understand what
happens during the process of ECT, only that the brain seizures that
result from the treatment do seem to have short-term benefits. Sometimes
these benefits are enough to save a life, and therefore ECT will always
have a place in the arsenal of mental health treatment until such time
as a superior emergency treatment is made available.

Unfortunately, up to 50 % of patients who receive the treatment do
not receive any benefit, and of those who do, 60% will relapse. That
is why it is important to keep receiving ongoing mediation and counseling
in conjunction with ECT.

Neuropsychiatrists readily admit that they do not understand why ECT
appears to work on some occasions, and not others. Thus a particular
severely depressed patient may dramatically improve after a course of
therapy which commonly lasts 6 to 10 shock treatments over a period
of 1-2 weeks. The next patient may not. The reasons are unknown. What
is known is that the brain seizures that result from the electric shock
to the brain induce massive functional and even structural changes to
the brain, both of which appear to be therapeutic, at least in the short
term.

Because of the controversial nature of the treatment, its popularity
had dropped by the 1980s and 1990s but its use still persists today.
Permanent memory loss is one serious side effect of the treatment and
the most common reason for treatment refusal. It is certainly the case
that some patients who have undergone repeated rounds of ECT displayed
marked short and long term memory loss, and find it difficult to function
efficiently in everyday life.

As with any operation involving a general anesthetic, there are risks
involved in addition to the problems that accompany the act of voluntarily
inducing seizures to the brain. One of these is the rare phenomena that
plagues general anesthesia in general – that the anesthetic fails
to work properly and the patient is awake throughout the procedure and
yet is paralyzed and unable to alert staff to the problem. As with similar
instances in physical surgery, where the patient remains awake and feels
the pain of the incision and other procedures, this is an added risk
factor to the process of ECT.